Irena KOSTOVSKA, Svetlana CEKOVSKA, Katerina Tosheska TRAJKOVSKA, Sonja TOPUZOVSKA
Cyprus Journal of Medical Sciences - 2026;11(4):297-302
BACKGROUND/AIMS: Type 2 diabetes (T2D) is a metabolic disorder commonly accompanied by persistent low-grade inflammation, accelerated development of atherosclerosis, and gradual decline in renal function. The ratio of C-reactive protein (CRP) to high-density lipoprotein-cholesterol (HDL-C) has recently been proposed as a composite biomarker reflecting inflammatory activity and anti-atherogenic capacity. The present study aimed to investigate the relationship between the CRP/HDL-C ratio and the presence of coronary artery disease (CAD) as well as the stages of chronic kidney disease (CKD) in individuals with T2D. MATERIALS AND METHODS: A total of 148 individuals with T2D were enrolled in this cross-sectional study: 56 patients without CAD and 92 patients with CAD confirmed by angiography; additionally, 44 healthy controls were included. Renal function and CKD staging were determined from the estimated glomerular filtration rate (eGFR) calculated using the CKD-epidemiology collaboration equation. Clinical characteristics and a broad range of biochemical, inflammatory, lipid, and renal markers were evaluated, and the CRP/HDL-C ratio was derived for each participant. Statistical analysis included intergroup comparisons, Spearman correlation testing, and receiver operating characteristic (ROC) curve analysis. RESULTS: T2D patients, particularly those with CAD, had significantly higher CRP levels, CRP/HDL-C ratios, blood pressure, glucose levels, abnormal lipid levels, and lower eGFR than controls (p<0.001). Progressive stages of CKD were associated with worsening renal function, elevated CRP levels, poor glycemic control, and dyslipidemia. The CRP/HDL-C ratio correlated positively with age, body mass index, fasting blood glucose, glycated hemoglobin, total cholesterol, triacylglycerols, low-density lipoprotein cholesterol, and blood pressure, and correlated negatively with eGFR and serum creatinine. ROC analysis demonstrated that the CRP/HDL-C ratio had good discriminatory ability for the presence of CAD (area under the curve 0.82; 95% confidence interval: 0.740-0.890), with an optimal cut-off value of 2.2, sensitivity of 78%, and specificity of 75%. CONCLUSION: The CRP/HDL-C ratio is significantly associated with cardiovascular and renal complications in T2D. An elevated ratio reflects increased inflammatory burden, dyslipidemia, and renal impairment, supporting its potential role as a simple and accessible biomarker for cardio-renal risk assessment in patients with T2D.
